New member Vetsulin dosing advice please

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Some vets do not like to prescribe Ondansetron for some reason. It is a human medication that is very effective at controlling nausea. You would have to get it from a pharmacy. I have had to use both in my cats before. For vomiting, Cerenia is very good and it will help a little with nausea. If it's not really making him feel better, I would get the Ondansetron. When he eats, does he go up to his food and sniff it and walk away? Does he maybe just do a lick or two and then walk away? Does he every make strange sounds when he is eating that sound like tooth grinding or similar sounds?

No he doesn't sniff and walk away or take a few licks and walks but he is probably only eating maybe half of his normal amount each time. Yes he does make the tooth grinding sounds sometimes.

Before diagnosis he let me know when he was hungry, now it is only in the morning that he asks for food but eats whenever I offer.
 
No worries, you're here now, and you're doing all the right things.

You can do fluids at home by the way, will probably save you quite a bit of hassle (and money). Suzanne will be better to help with CKD, if that's what it is...from what I understand renal failure and CKD can be different things.

Let's start here - skip insulin for the next 2-3 days and check back in (you can tag me using the '@' symbol - just as you see here @FrostD ). Continue to test at what would be your normal shot times, and try to get another about 3 hours after he eats. No need to test all day - no insulin, no hypo with Vetsulin. If you get a reading higher than 175 let me know as well.

In the meantime, go out and pick up some urine ketone test strips (like Ketostix), if you're in the US should be over the counter at any store with a pharmacy, like Walmart, CVS, etc. Try to get one test a day - if it shows anything other than negative, let us know ASAP. Follow the directions on the back of the bottle, the read time has to be exact because the syrup can change over time. Some people slide a (dedicated!) soup ladle under them to get a sample, others cover the box with Saran wrap. I have an empty litterbox I use for collecting urine, I just sprinkle a tiny bit of litter in one corner and for whatever reason that's enough to convince him to go. Cannot dip it in the litter, as the litter itself may mess with the readings. I'm not expecting any ketones with these numbers but always good to check when there's a drastic reduction in insulin.

@FrostD

Double checked his ketones and this is what we have at the 15 second timer mark.



Double checked on Ketones and this is what I have at th
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I seriously hate when that happens, like that wasn't even a color option! Can you dip one in just regular water and see how it comes out?
 
I seriously hate when that happens, like that wasn't even a color option! Can you dip one in just regular water and see how it comes out?

No color change at all with water

I tested the urine with 2 different sticks and got the same result

tested his blood 30 mins ago and it was 113
 
Ok. Don't exactly like the purple even though it doesn't match anything. How's he acting? Can you get a BG test in soon?

I did about 75 mL fluids 3 hours ago
Tested his BG 30 mins ago and it was 113 but will do again if needed.
He had a little bit of food 20 minutes ago and now he has gone back to sleep.
 
Ok. I am asking a few people so hold tight. We don't consider that purple negative but it doesn't really match anything either. It's not safe to give insulin right now.

Is he lethargic at all? I know you said he hasn't been eating as much but was it "normal for him" today?

What color was the one you did this morning?
 
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Ok. I am asking a few people so hold tight. We don't consider that purple negative but it doesn't really match anything either. It's not safe to give insulin right now.

Is he lethargic at all? I know you said he hasn't been eating as much but was it "normal for him" today?

What color was the one you did yesterday?

Yes his eating was his "normal for him" today, he does sleep a lot since he has been diagnosed. Still gets up to eat and use the litter box. Gets up when he hear's the freeze dried treats jar. Other than that he is always on the bed. Yesterday's test was the negative color.
 
I don’t know what to make of that color either. So strange. I used a blood ketone meter called the Nova Max Plus. That doesn’t help now. How old are your ketone strips. Do they have an expiration date on the bottle?
 
I don’t know what to make of that color either. So strange. I used a blood ketone meter called the Nova Max Plus. That doesn’t help now. How old are your ketone strips. Do they have an expiration date on the bottle?

They have an unopened expiration date of 2023 and I just opened it a couple of days ago.
 
Ok. At this point I have to assume he does have some ketones, which puts you in a bit of a pickle.

The ideal first step is finding a blood ketone meter to get an actual value and confirm, but I am guessing your vet may not have one or may not be open. They aren't usually sold in stores but you can look online to see if a store nearby maybe has one. You could try a different brand of ketones strips as well.

The official recommendation would be to take him to vet to get checked out. He may need even more fluids if there are ketones present. What we don't want is for this to progress to DKA. So need to keep him eating, keep him drinking.

I'd also keep an eye out for infection returning. It's possible the antibiotics didn't fully clear it, which makes DKA risk higher.

Now comes the question of insulin - it guards against DKA. So normally at these numbers I would say skip because it's very close to normal range and we just don't have the data. But given the potential ketones, the recent infection, it may be better to try 0.1U - just a hairline of insulin drawn up into the syringe, barely anything. The problem with this is I have no idea how low it may take him. You have a hypo kit, the 2U didn't drop him too horribly low (just much lower than we like for Vetsulin, and not a lot of data before you started the testing).

So unfortunately you really have to weigh your options and risks, and decide what path to take. You could take him in, but you mentioned financial constraints. You could just keep him eating and drinking as much as you can and skip insulin, but the risk of DKA is there. You can keep him eating and drinking and give that small dose, but still no guarantee against DKA and risk of low BG/hypo.
 
Ok. At this point I have to assume he does have some ketones, which puts you in a bit of a pickle.

The ideal first step is finding a blood ketone meter to get an actual value and confirm, but I am guessing your vet may not have one or may not be open. They aren't usually sold in stores but you can look online to see if a store nearby maybe has one. You could try a different brand of ketones strips as well.

The official recommendation would be to take him to vet to get checked out. He may need even more fluids if there are ketones present. What we don't want is for this to progress to DKA. So need to keep him eating, keep him drinking.

I'd also keep an eye out for infection returning. It's possible the antibiotics didn't fully clear it, which makes DKA risk higher.

Now comes the question of insulin - it guards against DKA. So normally at these numbers I would say skip because it's very close to normal range and we just don't have the data. But given the potential ketones, the recent infection, it may be better to try 0.1U - just a hairline of insulin drawn up into the syringe, barely anything. The problem with this is I have no idea how low it may take him. You have a hypo kit, the 2U didn't drop him too horribly low (just much lower than we like for Vetsulin, and not a lot of data before you started the testing).

So unfortunately you really have to weigh your options and risks, and decide what path to take. You could take him in, but you mentioned financial constraints. You could just keep him eating and drinking as much as you can and skip insulin, but the risk of DKA is there. You can keep him eating and drinking and give that small dose, but still no guarantee against DKA and risk of low BG/hypo.

Ok, I think I am going to go with a hairline of insulin and I will monitor him closely. Should I see if he will eat again before I do? It has been an hour since he ate last. I just looked for a test kit locally and can't find one but ordered one that will be here tomorrow, I know that doesn't help me now.

Thank you again so much for your time and advice.
 
Ok, I think I am going to go with a hairline of insulin and I will monitor him closely. Should I see if he will eat again before I do? It has been an hour since he ate last. I just looked for a test kit locally and can't find one but ordered one that will be here tomorrow, I know that doesn't help me now.

Thank you again so much for your time and advice.
Yes, try to get him to eat at least a 2 tsps, then go ahead and give the shot (that last meal will help keep him afloat as well). I wouldn't let him gorge himself because if he does drop lower, you do need him a bit hungry then. You'll want to test him hourly for sure, I'll stay with you as long as I can. I'll also tag @Bandit's Mom and @Bron and Sheba (GA) who are usually around at night
 
Yes, try to get him to eat at least a 2 tsps, then go ahead and give the shot (that last meal will help keep him afloat as well). I wouldn't let him gorge himself because if he does drop lower, you do need him a bit hungry then. You'll want to test him hourly for sure, I'll stay with you as long as I can. I'll also tag @Bandit's Mom and @Bron and Sheba (GA) who are usually around at night

Ok, thank you!
 
Another thought, if your vet is still open you can call and mention the ketones and see if it's possible to give him more fluids. Although I don't exactly trust your vet...

I'm not sure how much he's had today or recently, I'm not sure how his heart is, etc.
 
Another thought, if your vet is still open you can call and mention the ketones and see if it's possible to give him more fluids. Although I don't exactly trust your vet...

I'm not sure how much he's had today or recently, I'm not sure how his heart is, etc.

He isn't open. I am not trusting him either. We did 75 mL about 4 hours ago.
 
The concern about potential infection is the reason that I said you need to take him back to check his white count and other blood work. My boy went into DKA due to an infection of unknown origin. His temp was 105 when I took him in. Of course, he was vomiting a lot as well. But Marvin is eating. Honestly, a cat with numbers so high (that BUN) who is still eating gives me good hope. Marvin is not vomiting.
 
The concern about potential infection is the reason that I said you need to take him back to check his white count and other blood work. My boy went into DKA due to an infection of unknown origin. His temp was 105 when I took him in. Of course, he was vomiting a lot as well. But Marvin is eating. Honestly, a cat with numbers so high (that BUN) who is still eating gives me good hope. Marvin is not vomiting.
Yes and how many times have we seen antibiotics not fully clear whatever is going on. My worry as well.
 
The safest water for him is to get him to drink on his own. That water cannot pool in the wrong place. Water his food if he will eat it. If he likes tuna water you can get him to drink some watered down tuna water.
 
Ok, thank you![/QUOTE
Yes, try to get him to eat at least a 2 tsps, then go ahead and give the shot (that last meal will help keep him afloat as well). I wouldn't let him gorge himself because if he does drop lower, you do need him a bit hungry then. You'll want to test him hourly for sure, I'll stay with you as long as I can. I'll also tag @Bandit's Mom and @Bron and Sheba (GA) who are usually around at night

Ok, got 2 tsps into him, checked his BG it was 111. Gave him the insulin and set a whole bunch of alarms for every hour.

Thank you for your help!
 
Please let me know what time you shot, and which time zone you are. I would start with a test 45 mins after the shot
 
The safest water for him is to get him to drink on his own. That water cannot pool in the wrong place. Water his food if he will eat it. If he likes tuna water you can get him to drink some watered down tuna water.

Yes I do add water to every meal and he does drink some out of the water dish on his own but I am not sure it is enough. His urine output is getting smaller. I wanted to have fluids here more so as a "just in case" and have no problems giving him less or even every few days or weekly as needed.
 
Yes I do add water to every meal and he does drink some out of the water dish on his own but I am not sure it is enough. His urine output is getting smaller. I wanted to have fluids here more so as a "just in case" and have no problems giving him less or even every few days or weekly as needed.
I do believe that he needs the 100 mL per day. Some vets would recommend more.
 
Yes, try to get him to eat at least a 2 tsps, then go ahead and give the shot (that last meal will help keep him afloat as well). I wouldn't let him gorge himself because if he does drop lower, you do need him a bit hungry then. You'll want to test him hourly for sure, I'll stay with you as long as I can. I'll also tag @Bandit's Mom and @Bron and Sheba (GA) who are usually around at night

BG was 114 at 8:30pm
 
They also have a 2023 expiry date and the batch I am using now was opened 2 day ago.

OK....one more question....on the ketone strip with the funky purple color....did you take the picture at exactly 15 seconds? Every second past that will also cause the strip to get darker and darker
 
OK....one more question....on the ketone strip with the funky purple color....did you take the picture at exactly 15 seconds? Every second past that will also cause the strip to get darker and darker

Yes, right at the second that the timer hit 15. I did 2 strips and got the same result at 15 seconds.
 
His urine output is getting smaller
This is troubling to me as it is not the normal thing for a cat with kidney disease to do. I guess the vet assistant did not give you any of the other blood work from his file today. I wish we had some earlier results to compare to. I don’t even know what his hematocrit is and if he may be anemic. He probably needs some B-Complex and B-12 injections. If he’s anemic he may need some other medication. I can’t stop my mind from thinking about Marvin and what’s going on with him. But he seems better than his numbers (at least on April 11) would seem to indicate. I am concerned that he needs IV fluids. I’m hoping for better things for tomorrow.
 
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